Utilization Review Technician jobs in Idaho Falls, ID

Utilization Review Technician conducts utilization reviews to determine if patients are receiving care appropriate to illness or condition. Monitors patient charts and records to evaluate care concurrent with the patients treatment. Being a Utilization Review Technician reviews treatment plans and status of approvals from insurers. Collects and complies data as required and according to applicable policies and regulations. Additionally, Utilization Review Technician consults with nurses and physicians as needed. Position is non-RN. May require an associate degree or its equivalent. Typically reports to a supervisor. May require Registered Health Information Technician (RHIT). The Utilization Review Technician gains exposure to some of the complex tasks within the job function. Occasionally directed in several aspects of the work. To be a Utilization Review Technician typically requires 2 to 4 years of related experience. (Copyright 2024 Salary.com)

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Utilization Review Nurse
  • Mountain View Hospital Llc
  • Idaho Falls, ID FULL_TIME
  • Mountain View Hospital is looking for a Case Manager/Utilization Review to join our team!


    JOB SUMMARY:

    Performs utilization review activities in accordance with all state and federal mandated regulations in order to evaluate the necessity, appropriateness and efficiency of medical services provided. Maintains compliancy with regulation changes affecting utilization review and case management. Reviews patient’s records assists in evaluating patient’s progress and performs continuing review for identification and need of on-going hospitalization. Obtains and reviews necessary medical records and subsequent treatment plans to conduct reviews. Reviews and validates physician orders are carried out, reports progress and unusual occurrences on patients to department supervisor. Ensures cost effective and appropriate health care services are provided to all patients regardless of patients funding. Assists in maintaining review and appeal logs, participates in interdisciplinary collaboration with professional staff. Assists collaborating with other departments in discharge planning. Supports clinical improvement activities of Mountain View Hospital and Idaho Falls Community Hospital by providing quality review. Performs administrative duties; receives and generates a variety of reports as needed. Assists in assessing the physical, functional, social, psychological, environmental and financial needs of patients. Assists with referrals to appropriate community resources and contributes to the assessment of patient’s support systems. Acts as a patient advocate by assisting in acquiring appropriate medical, nursing or other health care in the home or clinic setting as needed upon discharge. Maintains accurate patient records, ensuring patient confidentiality. Contributes and assists in the performance of case management activities, and contributes to the assessing, planning, implementing, coordinating, monitoring and evaluating of the needs of patients for services both during and after hospitalization. Assists the department head in the supervision of the utilization of resources to promote quality, cost-effective outcomes for the patient and the patient’s family.


    BENEFITS
    :

    Taking care for our community starts with taking care of our own team. Mountain View Hospital is proud to offer its employees competitive and comprehensive benefit packages. Benefits include:

    • Medical, Dental and Vision Insurance
    • Paid Time Off (vacation, holidays and sick days) and Medical Paid Time Off
    • Retirement Plans (401K with up to 6% match)
    • Earned Quarterly Bonus Program
    • Education Reimbursement Program
    • Discount for medically necessary procedures performed at Mountain View Hospital and Idaho Falls Community Hospital
    • Life Insurance
    • Short- and Long-Term Disability
    • Flexible Spending Accounts
    • Employee Assistance Program
    • Flexible Schedules
    • Collaborative and Supportive Work Environment

    Please note benefits are based on eligibility according to full-time, part-time or PRN status classification.


    DUTIES AND RESPONSIBILITIES:


    • Assist the Supervisor of the department with daily activities of the department including chart review, interaction with patients and physicians, and with the floor nursing staff as well as other departments within the facility.
    • Justify pre-admission, admission and continued stays per InterQual criteria, by utilizing the InterQual manuals, in accordance to severity of illness, intensity of service and discharge criteria.
    • Works closely with the department Supervisor, regarding Utilization Review and Case Management principles.
    • Performs utilization review and Case Management activities, and will be an active member of the utilization review committee.
    • Some interaction with physicians and hospital staff on Utilization Review and Case Management issues.
    • Assists with the Follow through on appeals for Medicare, Medicaid, and commercial insurances in an effort to retrieve funds from denied patient stays under the supervision of the department supervisor.
    • Assists in the Review of patient cases with Medicaid, via Qualis Health, and various commercial insurances, on an initial, concurrent and retrospective basis, using InterQual criteria to ensure appropriateness of patient’s length of stay.
    • Contribute to the collection of information on the patient’s level of functioning and personal living situation in order to develop an action oriented case management plan that is time specific to best assist the patient during their hospital stay and upon discharge from the facility.
    • Assist the multidisciplinary team with the execution of the case management plan to achieve the desired outcomes for the patient.
    • Monitors the case management plan, and reports to the department supervisor to make changes as needed, to achieve the desired outcomes for the patient, with the assistance of the utilization review / case management staff.
    • Assists with the arrangement of appropriate services for the client, both during the patients stay and after discharge, utilizing all resources.
    • Contributes to the monitoring of the patient during their hospital stay, and identifies specific needs which are reported to the department Supervisor so the team can intervene on the patient’s behalf when needed.
    • Assistant will be able to cover for the Supervisor in times of Supervisors absence from the department with the direction of Social Services LSW.


    About Mountain View:

    Mountain View Hospital and our 29 affiliate clinics are committed to providing compassionate, cutting edge care to our patients. We serve the entire Snake River Valley – all the way from Pocatello to Rexburg. Our medical capabilities span everything from wound care to urgent care, oncology to neurology, physical therapy to speech therapy, a Level III NICU, robust robotic surgery department and a continuously expanding rural health practice.


    Our work environment is mission driven, people-centric and supportive. It is what sets apart and makes people excited to come to work each day. If you are looking for a career where you can make a difference in your community, we invite you to apply.

    Education/Certification: Graduate from an accredited school of nursing with current license as an LPN or Registered Nurse in the state of Idaho, with specialized training and/or experience in Utilization Review. Strong knowledge of modern nursing principles, techniques, and procedures for the care of patients, with emphasis on growth and developmental needs of patients from birth to death. These skills may be obtained through formal educational programs, training or experience. A strong knowledge base is needed in medical terminology, anatomy and physiology, and concepts of disease.


    Experience:
    Minimum Three years nursing.


    Equipment/Technology:
    Computer and Internet experience


    Language/Communication:
    Excellent written and verbal skills


    Mathematical Skills:
    Excellent


    Mental Capabilities: Must have excellent critical thinking skills.


    Interpersonal:
    Shall at all times demonstrate professional behavior.


    Performance:
    Must work well under pressure and meet multiple deadlines, and be able to multi-task.

  • 8 Days Ago

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Utilization Review RN
  • Teton Valley Hospital
  • Driggs, ID OTHER
  • The Utilization Review Registered Nurse will monitor adherence to the hospital's utilization review plan to ensure the effective and efficient use of hospital services and monitor the appropriateness ...
  • 9 Days Ago

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Utilization Review RN
  • TETON VALLEY HEALTH CARE, INC
  • Driggs, ID FULL_TIME
  • The Utilization Review Registered Nurse will monitor adherence to the hospital's utilization review plan to ensure the effective and efficient use of hospital services and monitor the appropriateness ...
  • 12 Days Ago

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Utilization review coordinator
  • Mountain View Hospital
  • Idaho Falls, ID FULL_TIME
  • Job Details Level Experienced Job Location Energy Plaza - Idaho Falls, ID Remote Type N / A Position Type Full Time Education Level Licensed Practical Nurse Salary Range Undisclosed Travel Percentage ...
  • 17 Days Ago

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Case Manager / Utilization Review
  • MOUNTAIN VIEW HOSPITAL LLC
  • Idaho Falls, ID OTHER
  • Job Details Level: Experienced Job Location: Hospital Main Campus - Idaho Falls, ID Position Type: Full Time Education Level: Licensed Practical Nurse Salary Range: Undisclosed Job Category: Health Ca...
  • 1 Month Ago

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Case Management- Utilization Review/CDI-(FT)
  • Madison Memorial Hospital
  • Rexburg, ID FULL_TIME
  • The Clinical Documentation Specialist/Utilization Review RN is responsible for the evaluation of physician documentation utilizing their clinical expertise to support excellence in documentation and e...
  • 4 Days Ago

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0 Utilization Review Technician jobs found in Idaho Falls, ID area

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Surgery Technician
  • Eastern Idaho Regional Medical Center
  • Idaho Falls, ID
  • Description Hourly Wage Estimate: $22.39 - $31.34 / hour Learn more about the benefits offered for this job. The estimat...
  • 3/29/2024 12:00:00 AM

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Surgery Technician PRN
  • Eastern Idaho Regional Medical Center
  • Idaho Falls, ID
  • Description Hourly Wage Estimate: $22.39 - $31.34 / hour Learn more about the benefits offered for this job. The estimat...
  • 3/29/2024 12:00:00 AM

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Certified CVOR Technician
  • Eastern Idaho Regional Medical Center
  • Idaho Falls, ID
  • Description Hourly Wage Estimate: $28.55 - $44.25 / hour Learn more about the benefits offered for this job. The estimat...
  • 3/29/2024 12:00:00 AM

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Furniture Assembly Technician
  • SFS, Inc.
  • Idaho Falls, ID
  • Overview: Opportunity is part-time, on-going Assembly work for both in-store (Nationwide Office supply chain) and in-hom...
  • 3/29/2024 12:00:00 AM

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Cyber Warfare Technician
  • US Navy
  • Idaho Falls, ID
  • About Enlisted Sailors in the Navy Cryptology community analyze encrypted electronic communications, jam enemy radar sig...
  • 3/28/2024 12:00:00 AM

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Tire Technician
  • Ron's Tire & Motorsports Point S
  • Idaho Falls, ID
  • Job Description Job Description We are looking for a Tire Technician to join our team! Responsibilities: Repairing / cha...
  • 3/28/2024 12:00:00 AM

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Pharmacy Technician
  • Costco Wholesale Corporation
  • Idaho Falls, ID
  • Job Description Assists pharmacist to fill, dispense prescriptions for customers. Assists customers at counter, retrieve...
  • 3/28/2024 12:00:00 AM

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Environmental Technician - Nights
  • Jacobs
  • Idaho Falls, ID
  • We are looking for a nightshift Environmental Technician for the Spent Fuel Handling Recapitalization Project (SFHP) Fac...
  • 3/27/2024 12:00:00 AM

Idaho Falls is the county seat of Bonneville County, Idaho, United States, and the state's largest city outside the Boise metropolitan area. As of the 2010 census, the population of Idaho Falls was 56,813 (2016 estimate: 60,211), with a metro population of 133,265. Idaho Falls serves as the commercial, cultural, and healthcare hub for eastern Idaho, as well as parts of western Wyoming and southern Montana. It is served by the Idaho Falls Regional Airport and is home to the College of Eastern Idaho, Museum of Idaho, and the Idaho Falls Chukars minor league baseball team. It is the principal c...
Source: Wikipedia (as of 04/11/2019). Read more from Wikipedia
Income Estimation for Utilization Review Technician jobs
$57,057 to $79,615
Idaho Falls, Idaho area prices
were up 2.5% from a year ago

Utilization Review Technician in Winston Salem, NC
When considering cost of living, this places Durham, NC as 3rd out of the 4 largest nearby metros in terms of quality of life for Utilization Review Technicians**.
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Current National Pharmacy Technician Certification (PTCB, ExCPT or NCCT) required.
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Utilization Review Technician in Little Rock, AR
Based on our compensation data, the estimated salary potential for Utilization Review Technician will increase 16 % over 5 years.
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